Female Death Registration: Year: 1971 number: 4914
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PROVINCE OF NOVA SCOTIA — REGISTRATION OF DEATH
02 - 004914
1. PLACE OF DEATH County of Cape Breton If in City or Town Sydney
If death occured in a hospital or institution Sydney City Hospital
3. PRINT NAME OF DECEASED Evely, Gladys
4. Sex
Female
5. Citizenship
Canadian
6. Racial Origin
English
7. Single, Married
married
8. BIRTHPLACE Carbonear, Nfld
9. DATE OF BIRTH 8 22, 1903
10. AGE in Years67 Months11 Days28 | hrs or mins
11. Trade or profession at home
12. Kind of industry
13. Date last worked 14. Total years
15. If married name of spouse Nicholas Evely
16. NAME of Father William Pike
17. BIRTHPLACE Carbonear, Nfld
18. NAME of Mother Ursula Pike
19. BIRTHPLACE Carbonear, Nfld
20. Signature of Informant William Evely
address 206 Boone Ave., Toronto 10, Ontario
Relationship to deceased Son
21. Place of burial Forest Haven Memorial Gardens, Sydney-Glace Bay Highway, CB, NS
Date of burial July 21, 1971
22. Undertaker R. H. Fillmore Funeral Home Ltd., Sydney, NS
MEDICAL CERTIFICATE OF DEATH
23. DATE OF DEATH July 19, 1971
CAUSE OF DEATH
(a) Myocardial Infarction
(b) Acute Pulmonary Edema
(c) Cardiogenic Shock
other Coronary Artery Disease with Congestive Heart Failure
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Nova Scotia Archives — https://archives.novascotia.ca/vital-statistics/death/?ID=496989
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